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Studies show Nevirapine resistance poses no long term risk to mothers
Ministry of Health & Child Welfare
Extracted from The Financial Gazette
March 16, 2006

Women Who Take a Single Dose Nevirapine to Prevent Transmission of HIV to their Babies Can Still Use Nevirapine Successfully in Subsequent Pregnancies and for their Own Long-Term Antiretroviral Therapy.

Ministry of Health and Child Welfare (MOHCW) in collaboration with several of its PMTCT Technical & Financial partners would like the public to know that several key studies presented at the International Conference on Retroviruses and Opportunistic Infections (CROI) in February this year provide promising data about the long term impact of nevirapine resistance on women who took the drug to prevent mother to child transmission of HIV.

Women who had taken single dose nevirapine responded as favourably to the drug in a subsequent pregnancy or as part of combination therapy as women who had never been exposed to the drug. Data from five separate studies suggest that the presence of resistance, documented in earlier studies, does not limit future drug treatment options for women who have taken the drug in a single pill to prevent HIV transmission to their babies.

The following studies presented at CROI showed that virus resistance does not impact the subsequent effectiveness of nevirapine to prevent HIV transmission or to treat HIV infection with combination antiretroviral drug regiments that include nevirapine. These studies are good news for HIV positive women who take nevirapine to prevent transmission to their babies.

• A South African study showed that antiretroviral treatment regimens containing nevirapine showed equal effectiveness in fighting the virus in women who had never taken nevirapine compared to women who take had taken single dose nevirapine 18 to 36 months earlier.
• A Ugandan study showed that women who repeated use of single dose nevirapine in subsequent pregnancies experienced no increased risk of infant infection as compared to women without prior exposure to the drug.
• A study conducted in South Africa and Côte d'Ivoire produced similar results in women taking nevirapine in multiple pregnancies. In both "subsequent pregnancy" studies, the second pregnancy was 18 months to 2 years after the previous single dose nevirapine exposure.
• Women in Argentina who took a short course triple combination of drugs including nevirapine to prevent mother to child transmission had a low risk of developing resistance to nevirapine.
• In Zimbabwe, women who took short course AZT and women who took single dose nevirapine showed no difference in their response when they later started taking antiretroviral drugs including nevirapine, for their own health.

At last year’s Conference on Retroviruses and Opportunistic Infections, several studies raised alarms by demonstrating that women who take single-dose nevirapine to prevent mother to child transmission of HIV show resistance to the drug. However, more study was needed to determine if this resistance had any negative impact on the women’s subsequent treatment options. This year’s studies strongly suggest that this resistance does not negatively affect early health outcomes. While continued follow up is needed, these results reaffirm the importance of single dose nevirapine as one of several safe and effective drug regimens available to prevent infant infections in resource limited settings.

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